Comparing patient-reported outcomes with objective surgical outcome measures using wearable technology in lumbar spine surgery: A systematic review and meta-analysis.

Abstract

Patient-reported outcome measures (PROMs) are considered the gold standard for assessing recovery following lumbar spine surgery, but they are subjective and may incompletely capture functional change. Wearable technologies, such as accelerometers and activity monitors, offer objective and continuous data. The extent to which wearable-derived metrics correlate with traditional PROMs remains uncertain. To characterize the association between wearable-derived mobility metrics and PROMs following lumbar spine surgery and quantify domain-specific correlations. Systematic review and meta-analysis conducted according to PRISMA guidelines. A comprehensive search of PubMed/MEDLINE, Embase/Elsevier, and CINAHL was performed through August 2025, identifying 10,831 records. Eligible studies included patients undergoing lumbar surgery for degenerative conditions, reporting both PROMs and wearable-derived gait data, and providing correlation coefficients. For quantitative synthesis, studies reporting Pearson correlations of change in wearable-derived mobility metrics (e.g., step count, gait velocity) with change in PROMs were included. One effect per study per domain (disability, pain, health-related quality of life [HRQL]) was extracted at the first postoperative timepoint ≥6 weeks. Correlations were Fisher z-transformed and pooled under random-effects models. Fourteen studies met inclusion criteria, eight of which contributed to the meta-analysis. Pooled change-change correlations showed a strong association with disability (r = 0.646, 95% CI 0.475-0.770), moderate association with pain (r = 0.459, 95% CI 0.235-0.637), and weaker association with HRQL (r = 0.357, 95% CI 0.066-0.592). Gait velocity and composite indices had stronger correlations with PROM changes than daily step counts, which were less consistent. Wearable-derived mobility metrics significantly correlate with PROM changes following lumbar spine surgery, particularly for disability. These findings support the integration of wearables as complementary tools for postoperative outcome assessment and demonstrate the need for standardization of metrics, timing, and reporting to facilitate clinical adoption.